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Intervention Review

Hospital at home for acute exacerbations of chronic obstructive pulmonary disease

  1. Felix SF Ram2,
  2. Jadwiga A Wedzicha3,
  3. John J Wright4,
  4. Michael Greenstone5

Editorial Group: Cochrane Airways Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 24 AUG 2003

DOI: 10.1002/14651858.CD003573

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Additional Information

How to Cite

Ram FSF, Wedzicha JA, Wright JJ, Greenstone M. Hospital at home for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003573. DOI: 10.1002/14651858.CD003573.

Author Information

  1. 2

    Massey University - Auckland, School of Health Sciences, Auckland, New Zealand

  2. 3

    Royal Free & University College Medical School, London, UK

  3. 4

    Bradford Royal Infirmary, Bradford Institute for Health Research, Bradford, W. Yorkshire, UK

  4. 5

    Castle Hill Hospital, Cottingham, North Humberside, UK

*Toby J Lasserson, Community Health Sciences, St George's, University of London, Cranmer Terrace, Tooting, London, SW17 ORE, UK. tlassers@sgul.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Hospital at home schemes are a recently adopted method of service delivery for the management of acute exacerbations of chronic obstructive pulmonary disease aimed at reducing demand for acute hospital in-patient beds and promoting a patient centered approach through admission avoidance. However, evidence in support of such a service is contradictory.

Objectives

To evaluate the efficacy of "hospital at home" compared to hospital inpatient care in acute exacerbations of chronic obstructive pulmonary disease.

Search methods

The Cochrane Central Register of Controlled Trials; electronically available databases e.g. MEDLINE (1966-current), EMBASE (1980-current), PubMed, ClincalTrials, Science Citation Index and on-line individual respiratory journals; bibliographies of included trials were all searched and contact with authors was made to obtain studies. The most recent searches were carried out in August 2003.

Selection criteria

Only randomised controlled trials were considered where patients presented to the emergency department with an exacerbation of their chronic obstructive pulmonary disease. Studies must not have recruited patients that are usually deemed obligatory admissions.

Data collection and analysis

Two reviewers independently selected articles for inclusion, evaluated methodological quality of the studies and abstracted data.

Main results

Seven studies with 754 patients were included in the review. Studies provided data on hospital readmission and mortality both of which were not significantly different when the two study groups were compared (RR 0.89; 95%CI 0.72 to 1.12 & RR 0.61; 95%CI 0.36 to 1.05, respectively). Both the patients and the carers preferred hospital at home schemes to inpatient care (RR 1.53; 95%CI 1.23 to 1.90). Other reported outcomes included few studies.

Authors' conclusions

This review has shown that one in four carefully selected patients presenting to hospital emergency departments with acute exacerbations of chronic obstructive pulmonary disease can be safely and successfully treated at home with support from respiratory nurses. This review found no evidence of significant differences between "hospital at home" patients and hospital inpatients for readmission rates and mortality at two to three months after the initial exacerbation. Both the patients and carers preferred "hospital at home" schemes to inpatient care.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

The effects of early discharge schemes in people who have had COPD exacerbations

This review of "hospital at home" service has shown that patients presenting to hospital emergency departments with acute exacerbations of chronic obstructive pulmonary disease can be successfully treated at home when supported by visiting respiratory nurses at home. This review found no evidence of differences between "hospital at home" patients and hospital inpatients for readmission rates and mortality at two to three months after the initial exacerbation. Both patients and carers preferred "hospital at home" care to inpatient care. However, only one in four patients were suitable for "hospital at home" schemes.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

醫院在家方案─用於慢性阻塞性肺病急性發作

醫院在家方案是最近發展出來用以處理慢性阻塞性肺病急性發作的醫療服務，其目的在於降低急性醫院住院病床的需求，以及經由避免入院來促進以病人為中心的照護。然而，支持這項服務的證據仍有矛盾。

目標

評估「醫院在家」相較於住院照護在治療慢性阻塞性肺病急性惡化的效益。

搜尋策略

Cochrane Central Register of Controlled Trials、電子資料庫如MEDLINE(1966年至今)、EMBASE(1980年至今)、PubMed、ClincalTrials、Science Citation Index及網路呼吸學期刊；納入之試驗的參考文獻等均作搜尋且聯絡所得研究的作者。最近的搜尋是在2003年8月進行。

選擇標準

只考量納入因慢性阻塞性肺病到急診看病的患者為受試者的隨機控制試驗。研究必須不納入必須住院的患者。

資料收集與分析

兩名審查者獨立地選擇納入的文章、評估研究的方法學品質及摘取數據。

主要結論

七個研究共計754名病人納入回顧。兩研究組別(譯者按：「醫院在家」治療及住院治療)在再入院率及死亡率的數據均無顯著差異(依序為RR 0.89；95%CI 0.72至1.12 及RR 0.61；95%CI 0.36至1.05)。病人及醫療照護者皆認為醫院在家方案優於住院照護(RR 1.53；95%CI 1.23至1.90)。其他報告的治療結果並不多。

作者結論

本回顧顯示因慢性阻塞性肺病急性惡化到急診室看病的患者，在經過謹慎選擇四位中有一位在呼吸護理師的支持下可以安全且成功地在家中接受治療。本回顧並未發現「醫院在家」的病人及住院的病人在起初惡化後的兩三個月內的再入院率及死亡率有顯著差異的證據。病人及醫療照護者皆認為醫院在家方案優於住院照護。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在經過選擇的情況下，接受「醫院在家」服務的慢性阻塞性肺病急性發作的病人較喜歡此項服務，而其治療結果與接受住院治療的病人相同。本項有關「醫院在家」服務的回顧顯示，慢性阻塞性肺病急性發作到急診看病的患者在呼吸護理師的支持下可成功地在家中治療。本回顧並未發現「醫院在家」病人與住院治療的病人在起初惡化後的兩三個月內的再入院率及死亡率有顯著差異的證據。病人及醫療照護者皆認為「醫院在家」優於住院照護。然而，只有四分之一的病人適合「醫院在家」方案。

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